Provider Demographics
NPI:1790283075
Name:JACOBY, ARLEEN RODRIGUEZ (LSW)
Entity Type:Individual
Prefix:
First Name:ARLEEN
Middle Name:RODRIGUEZ
Last Name:JACOBY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PEBBLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1948
Mailing Address - Country:US
Mailing Address - Phone:973-634-4470
Mailing Address - Fax:
Practice Address - Street 1:903 PEBBLE CREEK CT
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1948
Practice Address - Country:US
Practice Address - Phone:973-634-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL063430001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical